© 2015 National Skill Set For Effective Case Management in AUS & NZ: Skills Workbook

Documentation by the CM demonstrates periodic risk stratification (risk assessment) and the implementation and review of interventions to enhance Client outcomes [S3D] Documentation by the CM demonstrates the communication of required statutory or mandatory reporting by the CM to the Client and/or key stakeholders, including the role and responsibilities of all parties [S3D] Documentation by the CM demonstrates the CM monitors compliance to legislation by the Client and/or key stakeholder/s and responds to any non compliance in accordance with the program/agency guidelines [S3D] The CM supports the Client in self advocacy, including (as applicable) the provision of education and information concerning self knowledge, their rights and responsibilities, communication and negotiation skills, finding support and developing an advocacy action plan [S3E] The CM reviews and/or adjusts the level of case management support provided to the Client subsequent to an evaluation of the Client’s self advocacy skills [S3E] The CM can demonstrate how they evaluate the Client’s self advocacy skills and/or support the Client to develop self advocacy skills. The CM facilitates access by the Client to resources, supports (informal/formal) and services for the support and development of the Client’s self advocacy skills [S3E] Documentation by the CM includes examples of the effective engagement of key stakeholders by the CM to advocate for Client specific needs [S3E] The CM recommends/refers the Client to a suitably qualified individual/service for independent advocacy advice and support for matters outside of the CM’s scope of practice and/or qualifications/expertise [S3E] Documentation by the CM demonstrates Client reviews are undertaken in accordance with the agreed timeframes in the Client care plan and the program/agency guidelines. The CM demonstrates responsiveness to the Clients changing needs by adjusting the frequency of reviews as required and/or requested by the Client [S4A] The CM undertakes a formal evaluation process in accordance with the program/agency guidelines [S4A] Documentation by the CM demonstrates periodic reviews of the Client rights and responsibilities pursuant to the program/agency guidelines [S4A] The CM reviews the Client’s consent in accordance with program/agency guidelines [S4A] The CM compares the expected outcomes documented within the Client’s goals against actual outcomes [S4A] The CM is able to consider any mitigating circumstances or extraneous events that may have resulted in unexpected Client outcomes [S4A] The CM documents feedback from the Client and/or key stakeholders and uses this information to evaluate progress toward the Client’s goals or impacts on the Client’s experiences [S4A] The CM compares the Client’s individual outcomes against other Client outcomes and the available current research [S4A] Client outcomes are recorded by the CM in accordance with program/agency guidelines [S4A] The CM reviews the Client’s level of competency/capacity to make informed decisions and/or seeks specialist opinion (as applicable) [S4A] The CM is able to demonstrate practices that promote the development/extension of resources for identified service gaps for the Client’s one-off needs [S4B] The CM uses outcomes data to estimate the level of case management required to support the Client and to determine if this fits within the available resources [S4C] Documentation by the CM demonstrates that the Client’s feedback and evaluation has been central to the review and adjustments to the agreed goals within the care plan [S4D] The CM analyses the Client’s perception of changes in their quality of life compared against prior quality of life information [S4D] The CM supports the Client in exploring options to improve their quality of life [S4D] Documentation by the CM demonstrates that the Client’s goals have been met, including the transition of the Client to another setting, agency or disengagement [S4E] Documentation by the CM demonstrates the Client and key stakeholder’s feedback is sought and received by the CM in accordance with program/agency guidelines [S4E] The CM facilitates the disengagement phase in accordance with the Client and key stakeholders (as applicable) expectations, needs and preferences and in accordance with the program/agency guidelines [S4E]

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National Skill Set for Effective Case Management Workbook

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Chapter One